National Women's Annual Clinical Report 2010

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Reproduction of material National Women’s, Auckland District Health Board, permits the reproduction of material from this publication without prior notification, provided that all of the following conditions are met: the information must not be distorted or changed, and National Women’s must be acknowledged as the source. Disclaimer The purpose of this publication is to promote discussion and audit of outcomes. The opinions expressed in this publication do not necessarily reflect the official views of National Women’s and Auckland District Health Board. Acknowledgements Steering Committee Kirsty Walsh Acting General Manager and Service Manager National Women’s Health Carolynn Whiteman Service Manager Newborn Service Paediatric Intensive Care, Paediatric & Congenital Cardiac Service Malcolm Battin Clinical Director Newborn Service Jenny McDougall Clinical Director Obstetrics Mahesh Harilall Clinical Director Gynaecology Pam Hewlett Acting Clinical Leader Midwifery Lesley McCowan Head of Department, Department of Obstetrics and Gynaecology Project Team Marjet Pot Project Co-ordinator Lynn Sadler Epidemiologist Andrea Hickman Data Management/Analyst The project team would like to thank the many people who have assisted in the production of this publication. Special thanks to all who provide, enter and check data used in this Annual Clinical Report, and especially to Julie Porfiriadis, Coralee Jones, Claire McKay, Joanna Chua, Denny Wood, Sophie Jillings, Mark Barrios, Steffi Richter, Louise Grey, Jan Marshall, Praveen Singh and Coila Bevan. Thanks also to those who have provided chapter comments, especially Dr Janet Rowan, Dr Lesley McCowan, Dr Emma Parry, Dr Jenny McDougall, Dr Mahesh Harilall, Dr Martin Sowter, Dr Lucille Wilkinson, Dr Martin Minehan, Dr Padmaja Koya, Betty Wilkings, Margaret Merrilees, Pauline Fakalata, Dr Anne Dezoete, Janice Taylor, Ines Blaj, Dr Katie Groom, Dr Tim Dawson, Dr Michelle Wise, Dr Ai Ling Tan, Dr Malcolm Battin. ISSN 1175-6667 This document is available on the National Women’s Health website http://nationalwomenshealth.adhb.govt.nz ii
It is my pleasure to present the 2010 National Women’s Annual Clinical Report. This year we have again made additions to the data contained in our report, specifically by including severe maternal morbidity data and socioeconomic deprivation data. The process of publishing and presenting our report is one of the ways we maintain our focus on continuous quality improvement. This allows us to feedback our results, both those we are proud of and those where we have room for improvement, to our staff, colleagues and consumers and receive their feedback. Feedback from those with whom we share our Report is greatly valued and each year we use this feedback to inform our continuous quality improvement processes. The quality of service we provide is thanks to our valued staff and again my thanks go to all members of staff who strive to ensure the best possible service for all women and babies who are cared for at National Women’s. A very special thank you goes to those members of staff whose enthusiasm, dedication and focus result in this our comprehensive Annual Clinical Report. Thank you for sharing this with us. Kirsty Walsh Acting General Manager, Clinical Services Women’s Health iii
Page 1: National Women’s Annual Clinical
Page 5 and 6: 7 LABOUR AND BIRTH OUTCOMES .......
Page 7 and 8: Table 50: Neonatal outcomes followi
Page 9 and 10: Table 153: Preterm birth and matern
Page 11 and 12: Table 258: Perinatal mortality rate
Page 13 and 14: Figure 53: Mode of birth (1991-2010
Page 15: Chapter 1 INTRODUCTION 1
Page 18 and 19: Chapter 8: Postnatal care This chap
Page 20 and 21: 1.5.3 Gynaecologic data quality As
Page 23 and 24: 2 SERVICE PROVISION 2.1 Maternity s
Page 25 and 26: 2.2.4 Antenatal and Postnatal Wards
Page 27 and 28: The service has access to the ACH L
Page 29 and 30: 2.5.3 University Links There are cl
Page 31 and 32: Reportable events All incidents (mi
Page 33: Chaptern 3 SUMMARY STATISTICS 19
Page 36 and 37: 3.2 Summary of maternal outcomes 20
Page 38 and 39: Rate Table 7: Perinatal related mor
Page 40 and 41: Maternal indicator Caesarean sectio
Page 42 and 43: 50 45 40 35 30 25 20 15 10 5 0 % Ep
Page 45 and 46: 4 MATERNAL DEMOGRAPHY This chapter
Page 47 and 48: 4.2.2 Maternal ethnicity When more
Page 49 and 50: % 60 50 40 30 20 10 0 NZ European M
Page 51 and 52: 4.5 Body mass index Thirty five per
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% 100 80 60 40 20 0 European Maori
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Women booked with a private obstetr
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5 ANTENATAL COMPLICATIONS This chap
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Ethnic differences in rates of pret
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of women under 20 with SGA babies s
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Perinatal deaths in term SGA infant
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The rate of multiple pregnancy rema
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Summary / Implications Multiple pre
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5.4.1 Demographic characteristics o
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5.4.5 Perinatal losses Diabetes Per
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A confirmed placental abruption is
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70 60 50 40 30 20 10 0 % Gestationa
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5.7 Body Mass Index Methods BMI is
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% European Maori Pacific Other Asia
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50 45 40 35 30 25 20 15 10 5 0 % Eu
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16 % 40 14 12 10 8 6 4 2 0 Iatrogen
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Table 38: Mothers with babies diagn
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6 LABOUR AND BIRTH This chapter inc
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Table 39: Maternal demographic char
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Table 40: Gestation at birth among
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Women given syntocinon prior to 3 c
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70 60 50 40 30 20 10 0 % NZ Europea
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6.5 Caesarean section WHA Maternity
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Caesarean section rate 60 50 40 30
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Sixty percent of para 1 women with
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6.6 Instrumental vaginal birth WHA
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Table 52: Neonatal outcomes followi
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6.10 Obstetric analgesia WHA Matern
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Table 56: GA use and mode of birth
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Table 58: Interventions and outcome
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Chaptern 7 LABOUR and BIRTH OUTCOME
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7 LABOUR and BIRTH OUTCOMES This ch
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7.2 Third stage management Methods:
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Table 61: Postpartum haemorrhage ra
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7.4 Emergency peripartum hysterecto
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Chaptern 8 POSTNATAL CARE 113
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8 POSTNATAL CARE This chapter provi
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% 90 85 80 75 70 65 60 55 50 45 40
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8.2 Postnatal admissions Methods Pr
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Table 70: Reason for admission to N
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Chaptern 9 NEWBORN SERVICES 123
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9 NEWBORN SERVICES This chapter pro
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9.2 NICU occupancy For 2010 the ver
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Number 700 600 500 400 300 200 100
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9.3.4 Reasons for admission to NICU
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9.4.3 Intraventricular haemorrhage
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246 for 2010. This number is higher
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9.4.8 Trends in the use of assisted
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9.4.10 Positive pressure ventilatio
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9.4.12 Term/post-term infants on as
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9.5.2 Survival of inborn babies (23
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20% 18% 16% 14% 12% 10% 8% 6% 4% AN
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9.5.10 Postnatal corticosteroids (A
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express milk for many weeks before
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9.9 Child Development Unit 9.9.1 Fo
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9.9.2 Development at 4 years of chi
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Chapter 10 PERINATAL MORTALITY 155
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10 PERINATAL MORTALITY This chapter
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Table 87: Perinatal related loss an
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10.5 Causes of perinatal-related de
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Chapter 11 SEVERE MATERNAL MORBIDIT
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11 SEVERE MATERNAL MORBIDITY This c
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Chapter 12 GYNAECOLOGY 167
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12 GYNAECOLOGY This chapter provide
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12.2 Termination of pregnancy Epsom
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12.3 Second trimester Termination o
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12.4 Gynaecology inpatient surgery
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Table 101: Demographic details of w
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ACHS Gynaecology Indicators: Injury
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12.5 Gynaecologic laparoscopic proc
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12.6 Hysterectomy Methods See Gynae
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% 80 70 60 50 40 30 20 10 0 Abdomin
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12.7 Urogynaecology Methods As in p
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Table 113: Complications of surgery
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12.8 Colposcopy Methods: The data p
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Referral smear cytology Table 117:
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The number of treatments and percen
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Number of patients 4.5 4 3.5 3 2.5
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12.9 Gynaecologic oncology surgical
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11.9.2 Gynaecologic oncology surger
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203
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Antenatal Summary screen; Reason fo
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Postnatal Mothers Destination to Wa
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APPENDIX 2. SUMMARY STATISTICS Tabl
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Table 135: Time trends in nullipari
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Table 141: Rates of smoking at book
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Table 149: LMC at birth and materna
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APPENDIX 4. ANTENATAL COMPLICATIONS
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Table 157: Demographic characterist
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4.4 Hypertensive disease Table 160:
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Table 164: LMC at birth and BMI (20
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APPENDIX 5. LABOUR AND BIRTH 5.1 In
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5.2 Outcomes following induction Ta
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Table 180: Mode of birth by LMC at
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5.5 Operative births Table 189: Pri
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Table 196: Referral for ECV (women
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APPENDIX 6. LABOUR and BIRTH OUTCOM
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APPENDIX 7. POSTNATAL CARE 7.1 Infa
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Table 213: Maternal destination fol
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Table 220: Admissions of inborn bab
Page 257 and 258:
Table 224: Admissions of outborn ba
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8.2.5 Antenatal corticosteroids Tab
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8.3.2 Intraventricular haemorrhage
Page 263 and 264:
8.4.1 Survival Table 240: Numbers o
Page 265 and 266:
8.5.4 Patent Ductus Arteriosus Tabl
Page 267 and 268:
Table 252: Inborn babies receiving
Page 269 and 270:
APPENDIX 9. PERINATAL MORTALITY Tab
Page 271 and 272:
Table 260: Cause of perinatal-relat
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10.2 Gynaecology Inpatient Surgery
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APPENDIX 11. GLOSSARY OF ABBREVIATI
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APPENDIX 12. DEFINITIONS Antepartum
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Lead Maternity Carer (LMC) The Lead
Page 281:
Standard primipara A woman with no
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